Description
Organizations around the world are using Lean to redesign care and improve processes in a way that achieves and sustains meaningful results for patients, staff, physicians, and health systems. Lean Hospitals, Third Edition explains how to use the Lean methodology and mindsets to improve safety, quality, access, and morale while reducing costs, increasing capacity, and strengthening the long-term bottom line.
This updated edition of a Shingo Research Award recipient begins with an overview of Lean methods. It explains how Lean practices can help reduce various frustrations for caregivers, prevent delays and harm for patients, and improve the long-term health of your organization.
The second edition of this book presented new material on identifying waste, A3 problem solving, engaging employees in continuous improvement, and strategy deployment. This third edition adds new sections on structured Lean problem solving methods (including Toyota Kata), Lean Design, and other topics. Additional examples, case studies, and explanations are also included throughout the book.
Mark Graban is also the co-author, with Joe Swartz, of the book Healthcare Kaizen: Engaging Frontline Staff in Sustainable Continuous Improvements, which is also a Shingo Research Award recipient. Mark and Joe also wrote The Executive’s Guide to Healthcare Kaizen.
Table of Contents
The Need for Lean Hospitals
Better Results with Lean
Why Do Hospitals Need Lean?
A Renewed Sense of Purpose
Lean Methods Are Not New to Healthcare
Toyota’s Role in Popularizing Lean
Origins of the Term Lean
Lean Is Proven to Work outside Automotive Factories
Lean Is Helping Hospitals Improve
Problems in Healthcare
Good Quality Costs Less
Interconnected Benefits
A Snapshot of Department Success: Laboratory, Children’s Health Dallas
From Departmental to Hospital- and System-Wide Success
Conclusion
Lean Lessons
Points for Group Discussion
Notes
Overview of Lean for Hospitals and Health Systems
What Is Lean?
Ohno’s Definition of Lean
Lean Thinking
The Toyota Triangle: Tools, Culture, and Management System
The "Toyota Way" Philosophy
Four Organizational Capabilities for Lean
Lean and Other Methodologies
What Lean Is Not
Conclusion
Lean Lessons
Points for Group Discussion
Notes
Value and Waste
Waste: A Global Problem with Local Solutions
Reducing Waste Is a Better Goal Than Reducing Cost
What Is Waste?
What Is Value? Start with the Customer
How Do We Define Value in a Broad Sense?
How Does Lean Define "Value?"
Examples of Value-Added and Non-Value-Added Activities
Learning to Identify and Describe Waste
There’s Not Always an Easy Answer
What Non-Value-Added Activities Are Required?
Non-Value-Added, Pure Waste
Conclusion
Lean Lessons
Points for Group Discussion
Notes
Observing the Process and Value Streams
Learning to See
How Do We Find Waste? Go and See
What Is a Value Stream?
Value Stream Mapping
Creating a Current-State Value Stream Map
The Future-State Maps
Breaking Down Silos and Reducing Suboptimization
Observing the Process
Activity of the Product
Activity of the Employee
Conclusion
Lean Lessons
Points for Group Discussion
Notes
Standardized Work as a Foundation of Lean
Helpful Standardization: From 171 Forms to Just Six
The Need for Standardized Work
The Toyota House Metaphor
Overview of the Lean Foundations
Lean Foundations: Standardized Work
Definition of Standardized Work
Standardized, Not Identical
Written by Those Who Do the Work
Considering How Long Tasks Take
Staffing Based on Data
Types of Standardized Work Documents
Standardizing Daily Routines
Defining Roles and Responsibilities
Quick Changeover as Standardized Work
Explaining Why through Standardized Work
Standardized Work Documents and the Standardized Work System
Measuring and Observing for Standardized Work Adherence
"Resistance" to Standardized Work?
Asking Why When Standardized Work Is Not Followed
Standardized Work Can Apply to Physicians
Lean and Checklists
Standardized Work for Raising Concerns
Standardized Work Can Apply to Leaders
Training through Standardized Work
Conclusion
Lean Lessons
Points for Group Discussion
Notes
Lean Methods: Visual Management, 5S, and Kanban
Lean Is More Than Tools, but Tools Can Help
Reducing Waste through Visual Management
Examples of Visual Management for Patient Flow
Examples of Visual Management to Prevent Process Problems
5S: Sort, Store, Shine, Standardize, and Sustain
Safety as a Sixth S?
Kanban: A Lean Approach to Managing Materials
Problems with Traditional Materials Systems
Trade-Offs with Inventory
Using Kanban to Replenish Supplies
Conclusion
Lean Lessons
Points for Group Discussion
Notes
Proactive Root Cause Problem Solving
The Tragic and Preventable Mary McClinton Story
Improving Quality and Patient Safety
Cultural Obstacles to Quality Improvement
Why Do Errors Occur?
Examples of Quality Improvement
Finding Root Causes and Preventing Errors
Workarounds and the Need for Fixing Root Causes
Asking Why Instead of Who
Start at the Gemba
Find Root Causes Using Simple Methods
A3 Problem Solving
Toyota’s Practical Problem Solving
Be Proactive and Use Failure Modes and Effects Analysis
Proactive Resolution of Near-Miss Problems
The Heinrich Safety Pyramid
Conclusion
Lean Lessons
Points for Group Discussion
Notes
Preventing Errors and Harm
A Serious Problem with Large, Unknowable Numbers
Moving beyond Blaming Individuals
The Darrie Eason Case
Creating Quality at the Source through Error Proofing
Being Careful Is Not Enough
Why 100% Inspection Is Not 100% Effective
Types of Error Proofing
Error Proofing, Not Dummy Proofing
Examples of Error Proofing in Hospitals
Stopping the Line (Andon)
Error Proofing the Error Proofing
Conclusion
Lean Lessons
Points for Group Discussion
Notes
Improving Flow
Lean Is Both Quality and Flow
Waiting: A Worldwide Problem
Targets without a Means for Improvement Might Lead to Improvement or Dysfunction
Focusing on Flow
Value Streams Should Flow Like a River
Uneven Workloads as a Barrier to Flow
Addressing Mura by Matching Staffing to Workloads
Improving Patient Flow
Improving Flow for Ancillary Support Departments
Conclusion
Lean Lessons
Points for Group Discussion
Notes
Lean Design
Better, Faster, and Cheaper
Understanding the Current State before Designing the Future
Lean Design at East Tennessee Children’s Hospital
Integrated Lean Project Delivery at Akron Children’s Hospital
Conclusion
Lean Lessons
Points for Group Discussion
Notes
Engaging and Leading Employees
Improving the Way We Manage
What Is a Manager’s Role?
Strategy Deployment
Common Management Problems
Lean as a Management System and Philosophy
A Daily Lean Management System
Performance Measures
Conclusion
Lean Lessons
Points for Group Discussion
Notes
Getting Started with Lean
How Do We Start?
The LEI Lean Transformation Model
Where Do We Start?
What Do We Call It?
Getting Started with Kaizen
Kaizen Events
Lean Transformation Projects
The Lean Project Team
Executive Sponsorship and Leadership
Starting from the Middle
Establishing a Model Line and a Road Map
Dedicating People to Lean Beyond Projects
The Lean Department
The Importance of Change Management
A Snapshot of Hospital Success: Avera McKennan Hospital & University Health Center
Conclusion
Lean Lessons
Points for Group Discussion
Notes
A Vision for a Lean Hospital and Health System
Introduction
When Is a Health System Lean?
What Would a Lean Health System Look Like?
What Would a Patient Experience in a Lean Health System?
What Would It Be Like to Work in a Lean Health System?
How Would We Describe a Lean Health System?
In Conclusion
Points for Group Discussion
Notes
Glossary
Index
